CMS Seeks Comments on Medicare Payments for New Laboratory Tests

CMS is in the process of determining the appropriate fee schedule placement and appropriate payment amount for new test codes, including new molecular pathology tests. There is much debate in the molecular pathology community about whether Medicare should pay for molecular pathology tests under the Medicare Clinical Laboratory Fee Schedule (CLFS) or the Medicare Physician Fee Schedule (PFS). Clinical diagnostic lab tests are paid under the CLFS, but if physician services are required in relation to the test, tests are typically paid under the Physician Fee Schedule (PFS). CMS is looking for feedback on the best way to determine which fee schedule to use.

A request for comment was included in the calendar year 2013 Physician Fee Schedule (PFS) proposed rule, which was published today in the July 30, 2012, Federal Register. The proposed rule is seeking comments specifically on whether the new codes represent clinical diagnostic laboratory tests that should be paid under the CLFS or physician services that should be paid under the Physician Fee Schedule (PFS). Comments in response to this request are due to CMS by September 4, 2012. If you submit comments, please forward a copy of your comments to AAB/NILA.

Click here for the section of the July 30, 2012, Federal Register (pages 44782-44787) on Payment of Molecular Pathology Services (6 pages).

Click here to view a copy of the July 30, 2012, Federal Register, Book 2 (of 2 books), pages 44722-45234 (515 pages).

CMS issued another request for comment in the Federal Register on May 29, followed by a public meeting on July 16, through which CMS is seeking feedback on the appropriate basis for determining payment amounts for new test codes under the CLFS for Calendar Year 2013. CMS will publish all comments received during the July 16 meeting by August 6, 2012. CMS will continue to accept comments on the proposed payment determinations through September 28, 2012. Again, please forward a copy of your comments to AAB/NILA.

Click here to view a copy of the May 29, 2012, Federal Register notice.

CMS intends to finalize payment rates for new test codes and to decide where the molecular pathology codes will reside--in the CLFS or in the PFS--in November 2012.